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目的:探讨临床路径管理在计划性剖宫产中的应用效果。方法:2012年7月～12月实施临床路径管理的计划性剖宫产孕妇250例为路径组,采用2012年1月～6月非临床路径管理的计划性剖宫产孕妇250例为对照组,路径组和对照组病例的纳入标准:(1)第1诊断为首选治疗方案符合ICD-9-CM-3:74.1子宫下段剖宫产手术编码者;(2)孕妇患有其他疾病时,但在住院期间不需要特殊处理,也不影响第1诊断的临床路径流程,可以进入路径组。对2组孕妇的住院天数、各种住院费用、各项指标的变异系数和构成比,以及患者的满意度和术后并发症等指标进行综合比较分析。结果:路径组住院天数比对照组缩短,但住院费用2组比较,差异无统计学意义,但住院费用构成比变化,路径组药费下降,但治疗费增加,2组间的药费和治疗费比较,差异均有统计学意义,路径组变异系数波动总体较对照组小,患者满意度有所提高,但术后并发症无明显改变。结论:临床路径应用在计划性剖宫产起到了规范医疗行为的作用。
Objective: To explore the application of clinical path management in planned cesarean section. Methods: From July to December 2012, 250 pregnant women with planned cesarean section who underwent clinical path management were enrolled in the study. 250 pregnant women with planned cesarean section under non-clinical path management from January to June 2012 were selected as the control group , Pathological group and control group were included in the criteria: (1) The first diagnosis was the first choice of treatment according to ICD-9-CM-3: 74.1 Cesarean section operation coder; (2) In pregnant women with other diseases, However, no special treatment is required during the hospital stay, nor does it affect the clinical pathways of the first diagnosis, and can enter the pathway group. The hospitalization days, various hospitalization expenses, the coefficient of variation and the constituent ratio of each index, as well as the indexes of patient satisfaction and postoperative complications were compared and analyzed comprehensively. Results: The length of hospitalization in the path group was shorter than that in the control group, but there was no significant difference between the two groups in hospitalization costs, but the change in the cost structure of hospitalization, the decrease in the cost of the path group, but the increase of the treatment cost, the medication and treatment The differences between the two groups were statistically significant. The variation of coefficient of variation of path group was smaller than that of control group. The degree of satisfaction of patients was improved, but the postoperative complication did not change significantly. Conclusion: The clinical pathway used in planned cesarean section has played a role in standardizing medical behaviors.